Do You Have Fibromyalgia or Lupus? How to Tell the Difference

Bottom Line

Fibromyalgia and lupus often occur together but require different treatments. These conditions share widespread pain and fatigue symptoms but have different underlying causes. Lupus responds well to autoimmune medications, while fibromyalgia benefits from comprehensive pain management and behavioral approaches. Accurate diagnosis typically takes 3 to 6 months and is essential, since progressive lupus can cause organ damage.

If you’re experiencing widespread pain, crushing fatigue, and have been told you might have fibromyalgia or lupus, you’re likely feeling confused and overwhelmed. These two conditions share so many symptoms that even experienced doctors sometimes struggle to tell them apart. The reality is that these conditions often occur together, creating a complex diagnostic picture that requires careful medical evaluation.

Understanding the key differences between fibromyalgia and lupus, and knowing that you might have both, can help you work more effectively with your healthcare team to get the right diagnosis and comprehensive treatment plan. Your fibromyalgia and lupus journey is unique, and finding the right approach takes time and patience.

Understanding Fibromyalgia in This Context

Before diving into the comparison, it’s helpful to understand what fibromyalgia is and why it’s so often confused with other conditions. Fibromyalgia is a chronic condition that causes widespread pain throughout the body, along with fatigue, sleep disturbances, and cognitive difficulties often called “brain fog.”

The underlying mechanism of fibromyalgia involves central sensitization, where the brain and spinal cord become hypersensitive to pain signals, according to 2016 research in Neuroscience.⁸ This means your pain processing system becomes overly reactive, amplifying normal sensations into painful ones. Unlike autoimmune conditions, fibromyalgia doesn’t cause inflammation that shows up in blood tests or damage to organs, though it can significantly impact your quality of life.

Fibromyalgia affects about 2 to 4% of adults, with symptoms that can vary dramatically from person to person and even from day to day. This variability, combined with the lack of specific blood tests, makes diagnosis challenging and often leads to years of uncertainty before getting answers.

What to Expect During Diagnosis

If you’re experiencing symptoms consistent with both fibromyalgia and lupus, the diagnostic process typically involves several steps and can require patience as doctors work to understand your unique symptom pattern.

For both conditions, your doctor will start with a detailed medical history. They’ll ask about your symptoms, when they started, what makes them better or worse, and how they affect your daily life. This conversation is crucial because both fibromyalgia and lupus can present very differently between individuals.

Blood tests play different roles for each condition:

• Lupus diagnosis relies heavily on blood tests that can detect specific autoantibodies and inflammation markers
• Fibromyalgia diagnosis involves blood tests primarily to rule out other conditions (including lupus), as there are no specific fibromyalgia markers

Timeline expectations vary:

• Lupus diagnosis may take 3 to 6 months as doctors wait to see if symptoms persist and blood tests remain positive
• Fibromyalgia requires symptoms to be present for at least three months before diagnosis
• Having both conditions diagnosed may take even longer, as doctors work to separate overlapping symptoms

What makes diagnosis challenging: A 2025 meta-analysis in Clinical Rheumatology found that people with lupus have nearly four times higher risk of also developing fibromyalgia compared to healthy individuals¹. This overlap means your symptoms might be caused by one condition, both conditions, or other factors.

Understanding the Key Differences

While fibromyalgia and lupus can feel remarkably similar from the inside, they’re fundamentally different conditions with distinct underlying mechanisms.

Lupus is an autoimmune disease where your immune system mistakenly attacks healthy tissues throughout your body. This creates measurable inflammation that shows up in blood tests and can affect multiple organs including your kidneys, heart, and brain, according to the 2019 EULAR/ACR classification criteria.²

Fibromyalgia involves changes in how your central nervous system processes pain signals. Your pain processing system becomes overly sensitive, amplifying normal sensations into painful ones. Recent research published in the Journal of Clinical Investigation (2021) suggests some people with fibromyalgia may also have autoimmune components⁷, though this remains experimental and is not part of routine diagnosis or treatment approaches.

The practical difference is significant for your health and treatment planning. Lupus can cause serious organ damage if left untreated. Fibromyalgia, though debilitating, doesn’t damage organs or joints; it also requires different treatment approaches to address the fatigue and brain fog. This is why accurate diagnosis is so crucial for determining the right treatment approach and understanding the long-term health implications.

Symptom Comparison: Fibromyalgia vs Lupus

Understanding these differences or patterns can help you communicate more effectively with your healthcare provider about which symptoms are most prominent and concerning for you.

When These Conditions Might Occur Together

Clinical research consistently shows that having lupus significantly increases your likelihood of also having comorbid fibromyalgia. A recent systematic review and meta-analysis in Clinical Rheumatology found that about 16% of people with lupus also meet the criteria for fibromyalgia¹ as opposed to about 4% of a non-lupus population, though some studies suggest this number could be higher.

Why they often occur together according to current research:

• Chronic pain from lupus may trigger central nervous system changes seen in fibromyalgia, according to 2025 research in Nature Reviews Rheumatology ⁹
• The stress of managing a chronic autoimmune disease may contribute to fibromyalgia development, according to a 2023 review in Orthopaedics & Rheumatology Open Access Journal¹¹
• Both conditions may share some common genetic or environmental risk factors, according to 2009 research in Arthritis Research & Therapy¹²
• Inflammation from lupus might affect pain processing pathways, according to 2024 research in International Journal of Molecular Sciences¹³

What this means for your care: If you have both conditions, your treatment plan needs to address both the autoimmune aspects of lupus and the pain processing changes of fibromyalgia. Current clinical practice guidelines recommend different types of medications and approaches working together, coordinated by an experienced healthcare team familiar with both conditions. This comprehensive, patient-centered approach recognizes that managing overlapping conditions requires specialized expertise and individualized care.

Treatment Approaches and What to Expect

Lupus treatments focus on controlling autoimmune activity. Clinical trials published in leading rheumatology journals show that modern lupus medications demonstrate strong outcomes⁴⁵, with many people achieving good disease control with proper treatment. The European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) guidelines emphasize that early, aggressive treatment can prevent organ damage and improve long term outcomes, though treatment requires regular monitoring for side effects and disease activity.²

Medications currently indicated for lupus include immune system suppressors, antimalarials like hydroxychloroquine, and targeted biologics that specifically block the immune system pathways causing inflammation. Because lupus can affect vital organs including kidneys and heart, treatment often needs to be more aggressive initially.

Fibromyalgia treatments focus on pain management and symptom relief. According to current clinical practice guidelines, FDA approved medications help about 1 in 10 people achieve substantial pain relief according to a 2025 Cochrane overview in Rheumatology⁶, while movement therapy and behavioral therapy shows some of the strongest evidence for improvement in systematic reviews. Most people need a combination of approaches rather than single treatments, as individual variation is enormous and finding what works takes time and patience.

Effective fibromyalgia treatment often includes medications like pregabalin or duloxetine, along with physical therapy, stress management techniques, and lifestyle modifications. Dietary changes may also help some people manage symptoms according to emerging research.

Key timeline expectations vary significantly between conditions. Lupus medications may take 3 to 6 months to show full effects⁴, while fibromyalgia treatments often require 6 to 8 weeks to determine effectiveness, according to the 2025 Cochrane overview⁶. Both conditions may need ongoing treatment adjustments over time, and combining treatments for both conditions requires careful coordination.

When These Conditions Might Be Worth Investigating

This table can help you prepare for conversations with your doctor about which specialist might be most helpful for your specific symptom pattern.

How to Optimize Your Diagnostic Experience

Questions to ask your doctor about your symptoms:

• Could I have both fibromyalgia and lupus at the same time?
• What specific blood tests will help distinguish between these conditions?
• How long should we wait before considering a definitive diagnosis?
• What symptoms should prompt me to call you between appointments?
• Should I get a specialist opinion?
• Which of my symptoms are most concerning and need immediate attention?
• How will we know if initial treatments are working?

How to track if your diagnostic process is providing answers:

• Keep a symptom diary noting pain levels, fatigue, and specific symptoms
• Track which symptoms respond to initial treatments
• Note any new symptoms that develop during the diagnostic process
• Record how symptoms affect your daily activities and quality of life
• Take photos of any rashes or visible symptoms for your medical records
• Monitor your response to any medications or treatments

Working with your healthcare provider to get accurate diagnosis:

• Be honest about all symptoms, even if they seem unrelated
• Bring a complete list of all medications and supplements you’re taking
• Ask for copies of all blood test results and what they mean
• Don’t hesitate to seek a second opinion if you feel uncertain about your diagnosis
• Consider bringing a family member or friend to appointments for support
• Prepare questions in advance and write down answers during visits
• Be patient with the process while advocating for your needs

Getting the right diagnosis can take time, but being an active participant in the process helps ensure you get the most accurate assessment possible.

Research Shows Important Distinctions

Recent studies have revealed significant differences between fibromyalgia and lupus that help explain why treatment approaches vary so much.

Diagnostic accuracy varies between conditions. According to the 2019 EULAR/ACR classification criteria, lupus diagnostic tests correctly identify the condition in about 96% of cases² because doctors can measure specific autoantibodies and inflammation markers in blood tests. Fibromyalgia diagnosis is more challenging, with current diagnostic methods correctly identifying the condition in about 78% of cases according to a 2020 study in Rheumatology³, primarily because there are no definitive blood tests per current ACR guidelines.

What this means for you: If your blood tests show lupus markers, doctors can be quite confident in that diagnosis. Fibromyalgia diagnosis requires more clinical judgment and ruling out other conditions, which is why it may take longer to feel certain about the diagnosis. A lupus diagnosis does not rule out a fibromyalgia diagnosis, if you continue to experience widespread pain, fatigue, brain fog, and other symptoms. 

Treatment response patterns differ significantly. High quality randomized controlled trials published in the New England Journal of Medicine (2020) and Immunological Medicine (2025) show lupus treatments have robust outcomes, with many medications helping 43% to 66% of people who try them⁴⁵. For fibromyalgia, while pharmacological treatments show more modest benefits, behavioral therapy approaches demonstrate stronger outcomes, with 73% of patients showing improvement in comprehensive digital therapy programs according to a 2024 study in Journal of Behavioral Medicine¹⁰. Individual responses still vary dramatically from person to person.

What this means for you: If you have lupus, there’s good reason to be optimistic about finding effective treatment. If you have fibromyalgia, you may need to try several different approaches to find what works for your specific situation. This doesn’t mean fibromyalgia is less treatable, just that the path to effective treatment may be more individualized.

When to Seek Professional Help

Seek immediate medical attention if you experience:

• Severe joint swelling or inability to move joints normally
• Fever with rash or other concerning symptoms
• Changes in urination, kidney function, or blood in urine
• Chest pain, difficulty breathing, or heart palpitations
• Severe depression or thoughts of self harm

Schedule follow up appointments for:

• Worsening fatigue or pain despite initial treatment
• New symptoms that concern you or don’t fit your current diagnosis
• Medication side effects that affect your quality of life
• Questions about your diagnosis or treatment plan
• Feeling like your current treatment isn’t working

Consider a specialist consultation if you have:

• Positive autoimmune blood tests
• Joint swelling or morning stiffness lasting more than an hour
• Family history of autoimmune diseases
• Symptoms that suggest lupus but fibromyalgia diagnosis doesn’t fully explain your experience
• Complex symptoms that your primary care doctor feels need specialist evaluation

Early consultation with specialists can help clarify your diagnosis and get you on the most effective treatment path more quickly. A multidisciplinary, patient-centered care approach, including rheumatologists, fibromyalgia specialists, and mental health professionals, often provides the best outcomes for people with these complex conditions.

How Swing Care Can Help

At Swing Care, we understand the complexity of navigating fibromyalgia diagnoses. Our medical team can help you understand your test results, develop treatment plans, and coordinate with your existing healthcare providers. If you or someone you know is experiencing symptoms that might be fibromyalgia, you can access specialists through virtual visits with Swing Care, with services covered by major insurance plans.

If you are experiencing symptoms that overlap between these conditions, our comprehensive assessment based on standardized diagnostic tools may help you determine whether you may need professional evaluation from a physician. However, this is not a diagnosis, and Swing Care clinicians are available for a consultation to discuss your symptoms and history. Visit www.swing.care to learn more or to check your insurance benefits.

Key Takeaways

The diagnostic journey for fibromyalgia and lupus can be complex, but you’re not alone. Recent research confirms that these conditions often occur together, which is why getting an accurate diagnosis requires patience and careful medical evaluation. Your experience is valid, and the right healthcare team will take your symptoms seriously.

Each condition requires different treatment approaches. Understanding whether you have fibromyalgia, lupus, or both helps determine which treatments are most likely to help you. While lupus treatments tend to show more predictable responses, effective options exist for both conditions.

Your individual response to treatment matters most. Research provides general guidance, but your personal experience with different treatments is what ultimately guides your care. What works for someone else may not work for you, and that’s completely normal.

Hope and help are available. Whether you have fibromyalgia, lupus, or both, effective treatments exist. The key is finding the right combination for your specific situation through evidence based, collaborative care that respects your individual needs and preferences.

You have more control than you might think. While you can’t control having these conditions, you can actively participate in your care by tracking symptoms, asking good questions, and working closely with healthcare providers who understand the complexity of your situation.

Remember that getting the right diagnosis and treatment is a process, not a single event. Be patient with yourself and your healthcare team as you work together to understand your unique situation and develop the most effective approach for your individual needs.

This information represents current medical evidence as of August 2025 and is intended for educational purposes only. Fibromyalgia and lupus diagnosis and treatment decisions should be made collaboratively with qualified healthcare providers who can assess individual circumstances. Evidence quality and treatment responses vary significantly between individuals. 

Medically reviewed by Dr. Andrea Chadwick, MD, MSc, FASA

Sources

1. Mistry, S., Daoud, A., Magrey, M. N., & Pamuk, O. N. (2025). The frequency of fibromyalgia in patients with systemic lupus erythematosus and associated factors: a systematic review and meta-analysis. Clinical rheumatology, 44(1), 9–21. https://doi.org/10.1007/s10067-024-07188-9

2. Aringer, M., Costenbader, K., Daikh, D., Brinks, R., Mosca, M., Ramsey-Goldman, R., Smolen, J.S., Wofsy, D., Boumpas, D.T., Kamen, D.L., Jayne, D., Cervera, R., Costedoat-Chalumeau, N., Diamond, B., Gladman, D.D., Hahn, B., Hiepe, F., Jacobsen, S., Khanna, D., Lerstrøm, K., Massarotti, E., McCune, J., Ruiz-Irastorza, G., Sanchez-Guerrero, J., Schneider, M., Urowitz, M., Bertsias, G., Hoyer, B.F., Leuchten, N., Tani, C., Tedeschi, S.K., Touma, Z., Schmajuk, G., Anic, B., Assan, F., Chan, T.M., Clarke, A.E., Crow, M.K., Czirják, L., Doria, A., Graninger, W., Halda-Kiss, B., Hasni, S., Izmirly, P.M., Jung, M., Kumánovics, G., Mariette, X., Padjen, I., Pego-Reigosa, J.M., Romero-Diaz, J., Rúa-Figueroa Fernández, Í., Seror, R., Stummvoll, G.H., Tanaka, Y., Tektonidou, M.G., Vasconcelos, C., Vital, E.M., Wallace, D.J., Yavuz, S., Meroni, P.L., Fritzler, M.J., Naden, R., Dörner, T. and Johnson, S.R. (2019), 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol, 71: 1400-1412. https://doi.org/10.1002/art.40930

3. Salaffi, F., Di Carlo, M., Farah, S., Atzeni, F., Buskila, D., Ablin, J. N., Häuser, W., & Sarzi-Puttini, P. (2020). Diagnosis of fibromyalgia: comparison of the 2011/2016 ACR and AAPT criteria and validation of the modified Fibromyalgia Assessment Status. Rheumatology (Oxford, England), 59(10), 3042–3049. https://doi.org/10.1093/rheumatology/keaa061

4. Furie R, et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J Med. 2020;383(12):1117-1128. https://www.nejm.org/doi/full/10.1056/NEJMoa2001180

5. Sato, R., Shimizu, M., Kondo, Y., Maruo, K., Kuroda, Y., Ebe, H., Yagishita, M., Umeda, N., Mogi, S., Ohyama, A., Kitada, A., Abe, S., Asashima, H., Miki, H., Tsuboi, H., & Matsumoto, I. (2025). Real-world effectiveness of belimumab and anifrolumab in systemic lupus erythematosus: comparable trends in disease activity and glucocorticoid reduction. Immunological medicine, 1–10. Advance online publication. https://doi.org/10.1080/25785826.2025.2528296

6. Andrew Moore, Julia Bidonde, Emma Fisher, Winfried Häuser, Rae Frances Bell, Serge Perrot, Souzi Makri, Sebastian Straube, Effectiveness of pharmacological therapies for fibromyalgia syndrome in adults: an overview of Cochrane Reviews, Rheumatology, Volume 64, Issue 5, May 2025, Pages 2385–2394, https://doi.org/10.1093/rheumatology/keae707

7. Goebel A, et al. Passive transfer of fibromyalgia symptoms from patients to mice. J Clin Invest. 2021;131(13):e144201. https://doi.org/10.1172/JCI144201

8. Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114-129. https://doi.org/10.1016/j.neuroscience.2016.06.006

9. Pisetsky, D.S., Eudy, A.M., Rogers, J.L. et al. Pain in systemic lupus erythematosus: emerging insights and paradigms. Nat Rev Rheumatol (2025). https://doi.org/10.1038/s41584-025-01290-1

10. Catella, S., Gendreau, R. M., Kraus, A. C., Vega, N., Rosenbluth, M. J., Soefje, S., Malhotra, S., Luciano, J. V., McCracken, L. M., Williams, D. A., & Arnold, L. M. (2024). Self-guided digital acceptance and commitment therapy for fibromyalgia management: results of a randomized, active-controlled, phase II pilot clinical trial. Journal of behavioral medicine, 47(1), 27–42. https://doi.org/10.1007/s10865-023-00429-3

11. Jain, H., Flores, S., Navarro Gonzalez, J., Paul, T., Diaz de Argueta, E., Nwosu, M., Sherpa, P. L., Dominguez de Ramirez, M. R., Rodríguez Falla, D. A., Natera, D., Basnet, P., Ibrahim, A. D., & Gomez, M. I. (2023). Neuropsychiatric factors involved in the development of fibromyalgia: A literature review. Ortho & Rheum Open Access Journal, 22(1), Article 556078. https://doi.org/10.19080/OROAJ.2023.22.556078

12. Oliver, J. E., & Silman, A. J. (2009). What epidemiology has told us about risk factors and aetiopathogenesis in rheumatic diseases. Arthritis Research & Therapy, 11(3), 223. https://doi.org/10.1186/ar2585

13. Weng, H.-R. (2024). Emerging molecular and synaptic targets for the management of chronic pain caused by systemic lupus erythematosus. International Journal of Molecular Sciences, 25(7), 3602. https://doi.org/10.3390/ijms25073602